Predictors for the occurrence of HIV seroconversion and HIV-associated mortality among transgender women include urban residence in the Southern United States, Black and Hispanic race/ethnicity, and use of methamphetamines. These study results were published in The Lancet HIV.

Data for this multisite cohort study were collected between 2018 and 2020 at from transgender women across 72 cities in the Eastern and Southern US. Researchers aimed to estimate the incidence of HIV infection among this population within a follow-up period of at least 24 months. Participants responded to a questionnaire about demographic characteristics, sexual orientation, and use of HIV post- and preexposure prophylaxis (PrEP). All participants were assessed for HIV infection via oral fluid testing. Significant predictors for the occurrence of HIV seroconversion or mortality were identified via logistic regression models.

Among participants included in the analysis, the median age was 28 (IQR, 23-35) years, 50% lived in the Northeastern US, 53% were White, 88% were born in the US, 23% identified as heterosexual, 71% attended some college, 53% had an annual income above the federal poverty line, 36% had full-time employment, and 46% had private insurance. Overall, 734 participants were enrolled on site and 578 were enrolled online.

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A total of 15 participants seroconverted during the study period. Overall, the incidence rate (IR) of HIV infection was 5.5 per 1000 person-years (py). In subgroup analyses, HIV incidence per 1000 py was higher among participants enrolled on site vs online (IR, 8.7 vs 1.6); Black vs both Hispanic and White participants (IR, 19.3 vs 9.9 vs 1.6); those aged 18 to 24 years vs 25 years and older (IR, 8.5 vs 4.2); those with vs without baseline PrEP use (IR, 11.2 vs 0.7); and those residing in the Southern vs the Mid-Atlantic or Northern US (IR, 10.3 vs 4.8 vs 3.0).

Predictors for HIV seroconversion included an indication for postexposure prophylaxis (relative risk [RR], 16.0), Black race/ethnicity (RR, 14.8), lack of telephone access (RR, 6.3), laboratory-confirmed sexually transmitted infection (STI; RR, 5.3), use of methamphetamines (RR, 4.7), and residing in the Southern US.

The mortality rate was 3.3 per 1000 py within the 2-year follow-up period. Trends in mortality were similar to those observed for HIV seroconversion, with the exception of increased mortality incidence among Hispanic individuals compared with both Black and White individuals (IR, 9.9 vs 4.8 vs 3.2, respectively).

Predictors of mortality included judicial arrest within the previous 12 months (RR, 10.1), laboratory-confirmed STI (RR, 8.4), and Hispanic race/ethnicity (RR, 7.4).

The findings of this study may not be generalizable to transgender women residing in other US regions.

According to the researchers, “Mortality rates and shared predictors of HIV incidence and premature death emphasise the importance of community calls for attention to structural factors and other threats to health and wellbeing alongside HIV for transgender women, particularly Black and Latinx transgender women.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Wirtz AL, Humes E, Althoff KN, et al. HIV incidence and mortality in transgender women in the eastern and southern USA: a multisite cohort study. Lancet HIV. 2023;S2352-3018(23)00008-5. doi:10.1016/S2352-3018(23)00008-5

This article originally appeared on Infectious Disease Advisor